Electronic cigarettes could have a huge effect on public health | Marcus Munafo, University of Bristol

June 20, 2016 2.17pm BST – Marcus Munafo – The Conversation

Tobacco still kills 6m people around the world every year. Despite huge public health efforts to help people quit and prevent young people starting, smoking remains the single greatest cause of ill health and premature death. And even with restrictions on tobacco advertising and smoking in public places, many young people continue to take up smoking. The situation is even worse in poorer countries, where support to stop smoking is limited, and tobacco control policies weaker.

So in light of this, how should we view the increasing popularity of electronic cigarettes?

image-20160620-8853-1qda1qwThe gadgets deliver a nicotine hit by heating a nicotine-containing propylene glycol (e-liquid) to create an aerosol (usually called “vapour”), which is inhaled. Put simply, they deliver nicotine almost as effectively as a conventional cigarette, but without the vast majority of other chemicals present in tobacco smoke (either from the tobacco itself, or as a result of the burning process).

A whole culture is emerging around “vaping”. Many devices offer a range of power settings, and a vast array of e-liquids is on offer, with varying nicotine contents and flavours. Enthusiasts often apply modifications to their devices, and engage in “cloud chasing” – competing to produce the largest and most interesting clouds of vapour. And yes, young people are experimenting with e-cigarettes (in the same way that they have always experimented with pretty much everything), although at the moment there is no strong evidence this is leading to subsequent cigarette use, or even long-term e-cigarette use.

The rapid growth in use of e-cigarettes, especially among smokers trying to cut down or quit, has taken the public health community and the tobacco industry by surprise. Both are struggling to catch up. Health professionals are hurrying to carry out research to develop evidence-based guidelines and policies. Meanwhile, the tobacco industry is buying up e-cigarette companies and introducing its own products onto the market.

So how concerned should we be about this emerging and disruptive technology?

Should we encourage existing smokers to use e-cigarettes to help them stop smoking, even if this means they continue using nicotine long-term? In the United Kingdom there is some consensus that smokers should be encouraged to use e-cigarettes if they feel they might help, and the National Centre for Smoking Cessation and Training is supportive of their use. Part of the reason many vapers feel so passionately about the subject (and react strongly when they feel that vaping is being unfairly attacked) is that for the first time, through the use of e-cigarettes, they have felt able to take control of their nicotine habit, stop smoking, and reassert some control over their health, without being medicalised in the process.

But a problem remains in the lack of information on the possible harm of e-cigarettes. This is unlikely to change any time soon, since the health effects of tobacco use can take several decades to emerge, and it’s probable the same will be true for e-cigarettes. Nothing is entirely risk-free, but the vastly reduced number of chemicals present in e-cigarette vapour compared to tobacco smoke means we can be confident that vaping will be much, much less harmful than smoking.

Heartening evidence

As part of the investigation into the effects of e-cigarettes, we investigated how the cells found in the arteries of the heart, known as human coronary artery endothelial cells, responded when they were exposed to both e-cigarette vapour and conventional cigarette smoke. We found the cells showed a clear stress response from the cigarette smoke, but not from the electronic cigarette. This suggests tobacco smokers may be able to reduce immediate tobacco-related harm by switching from conventional cigarettes to e-cigarettes.

Many people find it difficult to function without their first caffeine hit of the day. But no one is seriously calling for coffee shops to be dismantled or regulated. Nicotine is addictive, but much less so on its own than in tobacco, where other chemicals enhance its effect. At the doses consumed by vapers the harm is likely to be very low (although we need to continue to research this), and many vapers actually gradually move to zero nicotine content e-liquids, even while continuing to vape.

Of course, we may end up with a large population of long-term nicotine users who use e-cigarettes to deliver nicotine rather than cigarettes, but all of the evidence at the moment suggests that this population will almost entirely comprise ex-smokers. This would produce a vast public health gain.

We must be careful not to restrict smokers’ access to e-cigarettes, or over-state the potential harm of their use, if this will put people off making the transition from smoking to vaping. To do so would deny us one of the greatest public health improving opportunities of the last 50 years.

Original post – The Conversation | More on E-cigarettes from UKCTAS

New research from ASH Wales Cymru shows e-cigarettes are not a gateway to smoking for young people

New research released today shows no evidence that e-cigarettes are a ‘gateway’ for young people to start smoking. The annual survey, by tobacco control campaign group, ASH Wales Cymru, questioned more than 830, 11 to 18 year olds across Wales.

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For the third year running the survey shows there is no link between youths vaping and starting smoking tobacco.

It has been a concern among health professionals since the rapid emergence of e-cigarettes that they would ‘renormalise’ smoking and act as a ‘gateway’ towards tobacco for young people.

Of the young people who reported using both e-cigarettes and tobacco cigarettes at some point, 90% had used tobacco first, suggesting the absence of any ‘gateway’ theory. The report confirms e-cigarette use is confined to current smokers or ex-smokers and they are rarely used among ‘never’ smokers.

It also showed more than 30% of the e-cigarette users had quit smoking altogether. Reasons for using e-cigarettes varied from taste, to friends using them, to wanting to know what they were like.

Young people from the poorest parts of Wales were 25% more likely to have used an e-cigarette compared to their counterparts in the least deprived areas of the country.

These statistics around use by young people match recent results around adult usage from the Welsh Health Survey 2015.

This was the first time the Welsh Health Survey had looked at e-cigarette use. It revealed that 6% of over 16’s stated they currently use an e-cigarette – 140,000 of the Welsh population. Use among never smokers was negligible at 0.06%.

Suzanne Cass, Chief Executive of ASH Wales:

“For the third year in a row our research confirms young people are not using e-cigarettes if they’ve never smoked before.”

“E-cigarettes can contain highly addictive nicotine and there is no need for young non-smokers to use the devices. We are pleased to see these latest results confirm that e-cigarettes are being used as a smoking cessation device, similar to nicotine patches or gum and at the moment are not acting as a gateway towards tobacco.  E-cigarette users are now reducing the harm to their bodies caused by poisonous and cancer-causing tobacco smoke.”

Professor Linda Bauld from the University of Stirling and UK Centre for Tobacco and Alcohol Studies:

“There is a lot of confusion about the relationship between e-cigarettes and smoking in young people. Surveys from other countries do keep claiming there is a link despite youth smoking rates continuing to fall in the countries where these studies take place. This new data from Wales should reassure people that although young people are experimenting with e-cigarettes, we are not seeing regular use in never smokers. Meanwhile, youth smoking rates in Wales continue to decline, which is key to preventing cancer and other diseases that smoking causes.”

Ruth Coombs, Head of British Heart Foundation (BHF) Cymru:

“We are pleased that latest ASH Wales Cymru findings highlight encouraging trends to show that young people in Wales are not turning to e-cigarettes as a way to start smoking but rather as a way to reduce harm caused by intake of tobacco by cigarettes.”

 

Principal Findings:

  •  In terms of awareness of e-cigarettes, a large majority of respondents (90.7%) were aware of e-cigarettes. When stratified by age and gender the awareness of e-cigarettes remained extremely high. As many as 88.5% of respondents under the age of 13 were aware of what an e-cigarette is.
  • The most common sources of finding out about e-cigarettes were: seeing strangers using them in public (45.9%), reading or hearing about them on the internet or social media (42.6%), being told about them by friends (42.5%), and seeing them or hearing about them in the media (42.5%). By contrast only a very small proportion of respondents found out about e-cigarettes from a youth worker (3.3%) or health professional (3.0%).
  • The majority of respondents (68.6%) have never used an e-cigarette, with 13.7% only using an e-cigarette once and just 10% currently using an e-cigarette. A higher percentage of males reported currently using e-cigarettes every day (6.8%) relative to females (2.2%).
  • Respondents from the most deprived parts of Wales were far less likely to have never used an e-cigarette (48.6%) relative to respondents located in the least deprived areas of the country (75.4%).
  • The vast majority of never smokers have also never used an e-cigarette (88.9%), with a further 8.2% only ever having tried an e-cigarette once. Just 0.6% of never smokers currently use e-cigarettes regularly (i.e. more than once a week).
  • The main reasons for using e-cigarettes for the first time were to see what they tasted like (48.7%), because friends were using them (40.1%), and for a bit of fun (30.7%). 22.1% of respondents cited using e-cigarettes to reduce their intake of tobacco cigarettes.
  • The vast majority of respondents (90.3%) who had used e-cigarettes and smoked tobacco cigarettes reported starting to smoke tobacco cigarettes first.
  • Of the respondents who had used e-cigarettes and smoked tobacco cigarettes at some point (n = 172) 25.0% smoked fewer tobacco cigarettes since starting to use e-cigarettes, with 34.3% of respondents ceasing to smoke tobacco cigarettes altogether.

View the reportSee more on e-cigarettes | Other research from ASH Wales

The international symposium looking at Electronic Nicotine Delivery Systems & Smoking Cessation

La Rochelle – France

December 1st & 2nd, 2016

Tobacco will be the leading cause of death in the 21st century, and projections by the World Health Organization (WHO) are nothing short of alarming: 600 million deaths world-wide. The WHO considers smoking as “one of the most serious threats that ever faced mankind”.
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The e-cig symposium was created in this context and will present the latest research results on the potential of new electronic nicotine delivery devices in the form of electronic cigarettes, and more broadly, of aerosol therapy. Devices which, for the first time, may reveal potentially effective treatment solutions to stop smoking with confort and pleasure.
The e-cig symposium has clear objectives : gathering medical, scientific, and technical research to review and summarise the studies done on electronic cigarettes, and more globally on electronic nicotine delivery devices used as an alternative to tobacco smoking.
The e-cig event will:
  • present the latest research results on the potential of new electronic nicotine delivery devices in the form of electronic cigarettes, and more broadly, of aerosol therapy. Devices which, for the first time, may reveal potentially effective treatment solutions  to quit smoking with comfort and pleasure.
  • provide the latest research developments on the effectiveness and safety evaluation methods of electronic cigarettes, as well as on the standards and regulations of these products.
  • gather both public and private physicians and researchers working on topics directly or indirectly related to the delivery of nicotine and smoking cessation.

Who’s going to be there?

attendees.pngCall for communications is open: Be part of the e-cig panel speakers : +60 oral communications will be selected from the call for papers. Submit your paper below!

Program at a glance | Submit your abstract | More information

Royal College of Physicians’ & UKCTAS director John Britton discussing e-Cigarette Benefits & Regulation (RegulatorWatchCanada)

‘In this episode of RegWatch hear directly from John Britton, professor of epidemiology at the University of Nottingham and Chair of the Tobacco Advisory Group at the Royal College of Physicians. He led the team of experts that produced the comprehensive report. Get in-depth details on the findings and learn why Prof. Britton says vaping should not be easily dismissed’

Read more on Regulator Watch . com

Human heart cells respond less to e-cig vapour than tobacco smoke – University of Bristol

New research has showed substantial differences in the way human heart cells respond to e-cigarette vapour and conventional cigarette smoke.

Researchers from the Medical Research Council Integrative Epidemiology Unit (MRC IEU) at the University of Bristol investigated how the same type of cells as those found in the arteries of the heart, known as human coronary artery endothelial cells (HCAEC), responded when they were exposed to both e-cigarette aerosol and conventional cigarette smoke.

Their results were published in the journal Drug and Alcohol Dependence.

Professor Marcus Munafò, who was part of the study team, said: “The past few years have seen a rapid growth in the use of e-cigarettes, which deliver nicotine via inhaled aerosol. It’s thought that e-cigarettes are unlikely to be as harmful as conventional cigarettes, but little data exists to show their relative harms, or the long term effects of e-cigarette use. Therefore, research into these biological effects is critical. Our study looked at the stress response in heart cells in response to cigarette smoke and e-cigarette aerosol.”

The researchers created cigarette smoke extract from a conventional cigarette and electronic cigarette aerosol extract from an e-cigarette aerosol. Both were passed through a culture of the cells. The researchers then analysed the gene expression patterns of the heart cells to see if the cells exhibited a stress response to either the cigarette smoke or e-cigarette aerosol exposure.

Professor Munafò said: “We found the cells showed a stress response from the cigarette smoke extract, but not from the electronic cigarette aerosol extract. This result suggests tobacco smokers may be able to reduce immediate tobacco-related harm by switching from conventional cigarettes to e-cigarettes.”

Cigarette smoke but not electronic cigarette aerosol activates a stress response in human coronary artery endothelial cells in culture’ by Teasdale, Newby, Timpson, Munafo and White in Drug and Alcohol Dependence

Taken from: Bristol University News

The use of Nicotine Replacement Therapy (NRT) for smoking cessation by pregnant smokers – PHD Studentship

NIHR CLAHRC East Midlands, Division of Primary Care – PhD Studentship

Applications are invited for a 3 year, full time studentship aligned to the work of NIHR CLAHRC East Midlands and the School of Medicine at the University of Nottingham. A yearly stipend at current RCUK rates (£14,296) plus Home/EU tuition fees (£4,121) is available. The successful candidate will work into the CLAHRC’s Preventing Chronic Disease (PCD) theme. Continue reading

New RCP report says ecigs should be promoted to smokers to help them quit

A new report released today from the Royal College of Physicians, ‘Nicotine without smoke: tobacco harm reduction’ concludes that e-cigarettes are likely to be beneficial to UK public health. Smokers can therefore be reassured and encouraged to use them, and the public can be reassured that e-cigarettes are much safer than smoking.

Tobacco smoking is addictive and lethal. Half of all lifelong smokers die early, losing an average of about 3 months of life expectancy for every year smoked after the age of 35, some 10 years of life in total. Although smoking prevalence in the UK has reduced to 18%, 8.7 million people still smoke. Harm reduction provides an additional strategy to protect this group of smokers from disability and early death.

Since e-cigarettes became available in the UK in 2007, their use has been surrounded by medical and public controversy.  This new 200-page report examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine, and addresses these controversies and misunderstandings with conclusions based on the latest available evidence:

  • E-cigarettes are not a gateway to smoking – in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco
  • E-cigarettes do not result in normalisation of smoking – there is no evidence that either nicotine replacement therapy (NRT) or e-cigarette use has resulted in renormalisation of smoking. None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence of significant gateway progression into smoking among young people
  • E-cigarettes and quitting smoking – among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking
  • E-cigarettes and long-term harm – the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking. With appropriate product standards to minimise exposure to the other ingredients, it should be possible to reduce risks of physical health still further. Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.

The report acknowledges the need for proportionate regulation, but suggests that regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers. A regulatory strategy should take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.

Professor John Britton, chair of the RCP’s Tobacco Advisory Group, said:

‘The growing use of electronic cigarettes as a substitute for tobacco smoking has been a topic of great controversy, with much speculation over their potential risks and benefits. This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK. Smokers should be reassured that these products can help them quit all tobacco use forever.’

RCP president Professor Jane Dacre said:

‘Since the RCP’s first report on tobacco, Smoking and health, in 1962, we have argued consistently for more and better policies and services to prevent people from taking up smoking, and help existing smokers to quit. This new report builds on that work and concludes that, for all the potential risks involved, harm reduction has huge potential to prevent death and disability from tobacco use, and to hasten our progress to a tobacco-free society. With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people. It is an opportunity that, with care, we should take.’

Alison Cox, director of prevention for Cancer Research UK, said the charity believes e-cigs have a “real promise” in helping to reduce the death toll from tobacco.

She added: “This important report is an accurate summary of the latest scientific evidence on e-cigarettes and will help dispel the increasingly common misconception that they’re as harmful as smoking. They’re not.

“Tobacco kills more than 100,000 people in the UK every year, we should grasp every opportunity to encourage as many people as possible to stop smoking for good.”

And Duncan Selbie, chief executive at Public Health England, said the report highlights the “important role” of e-cigarettes in reducing the deadly harms smoking causes.

He added: “The best thing a smoker can do, for themselves and those around them, is to quit completely, now and forever.

“E-cigarettes are the most popular quitting aid in England and local stop smoking services are the most effective route to giving up, we encourage smokers to combine these, giving them an extremely good chance of quitting smoking successfully.”

Five researchers from the University of Nottingham were involved in the report.

These were Ilze Bogdanovica, research fellow; John Britton, professor of epidemiology; Tessa Langley, assistant professor in health economics; Sarah Lewis, professor of medical statistics; and Opazo Breton, research statistician.

News stories:

New York Times – Smokers Urged to Switch to E-Cigarettes by British Medical Group

Wall Street Journal – U.K. Report Advocates Substituting E-Cigarettes for Tobacco

Motherboard – Vaping Is About Reducing Harm, Not Being Harmless

Nottingham Post – Experts and doctors believe e-cigarettes should be offered to smokers